Get Delineation Of Clinical Privileges - Physical Therapy 1 - Armypubs Army

This guide provides you with clear instructions on how to effectively complete the DELINEATION OF CLINICAL PRIVILEGES - PHYSICAL THERAPY 1 form. Follow these steps to ensure accurate and efficient submission of your clinical privileges.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In Section I, fill in your name in the format of last name, first name, and middle initial. Ensure accuracy as this will be a formal record.
3. Enter your rank or grade in the designated field to indicate your position.
4. Provide the name of the facility where you are applying for privileges.
5. In the provider section of Section I, enter the appropriate provider code for each category and privilege you are requesting. For any privilege you do not wish to apply for, line through this and initial it as per instructions.
6. Ensure your signature is present at the end of Section I, confirming the information you submitted.
7. In Section II, the supervisor will review your requested privileges. They will fill in the appropriate approval code for each privilege. You will also need their signature and comments regarding their recommendations.
8. Once the supervisor has completed their review, the form will proceed to Section III, where the credentials committee will provide their recommendations along with approvals or modifications.
9. Once all sections are completed and signatures are obtained, review the form for accuracy before submission.
10. After finalizing, you can save the changes made to the form, download it for your records, print a hard copy, or share it electronically as required.

Complete your DELINEATION OF CLINICAL PRIVILEGES form online today for a seamless application experience.